THE ISSUE
One of the most vital tenets of medical ethics governing the patient-physician relationship is trust built on open communication about all health topics, including sexual and reproductive health. Access to comprehensive, evidence-based sexual and reproductive
health care services is critical for patient health. Patients have a right to seek care and be informed about their sexual and reproductive health, and they should have access to safe, effective, and affordable methods of family planning, fertility
management, abortion, and other reproductive health care. Despite the importance of accessible, high-quality reproductive care, state and federal lawmakers across the country continue to try to restrict or limit access, often by limiting a physician’s
ability to provide necessary medical care, actions the Medical Society sharply condemns.
Additionally, access to affordable, comprehensive perinatal health care is vital for ensuring safe pregnancies and childbirth. Currently, excessive out-of-pocket health care costs can put essential pregnancy-related care out of reach for those who need
it, harming patients, families, and birthing individuals. Moreover, there are long-standing racial inequities in maternal and child health outcomes in the Commonwealth, rooted at their core in racism and barriers to care.
OUR STANCE
The Massachusetts Medical Society is committed to protecting and advancing equitable access to the full spectrum of reproductive health care. This includes eliminating barriers to care, addressing the maternal health crisis, and safeguarding the right
to access contraception, abortion, fertility treatment, and gender-affirming care. Protecting equitable access to reproductive health care, including abortion, and the right to seek the trusted guidance of a physician, are essential to the health
and well-being of all who are or who may become pregnant. The MMS further recognizes that racial and ethnic disparities in maternal morbidity and mortality are inextricably linked to racism and is committed to ensuring everyone has access to comprehensive,
high-quality, and inclusive reproductive health care.
OUR ADVOCACY
The Medical Society is proud to play a meaningful role in advancing efforts to protect and increase access to reproductive health care in the Commonwealth and beyond. From abortion to protecting gender-affirming care to combating racial inequities in
maternal health, the MMS has had a seat at the table and helped to shape policies that will profoundly impact equitable access to reproductive health care.
Protecting and Expanding Access to Abortion
The Medical Society believes that abortion is an essential medical component in the continuum of reproductive health care and should be safely accessible in a collaborative, team-based model of care. Accordingly, the MMS condemned the Supreme Court’s
decision in Dobbs, which struck down the longstanding federal right to abortion, and reaffirmed our policy that abortion should be safely accessible to all, regardless of where you live. The Medical Society helped craft and supported the passage of
a 2022 Shield Law that increases access to affordable abortion care and establishes meaningful protections for physicians, providers, and our patients as we collectively navigate a post-Roe landscape.
The MMS also advocated for the passage of the ROE Act, most provisions of which became law in December 2020. It created an affirmative right to abortion in the state, expanded abortion access after 24 weeks in instances of lethal fetal anomalies, and
removed a parental consent requirement for 16- and 17-year-olds.
Contraceptive Access
The Medical Society supported the United States Food and Drug Administration (FDA) decision in July 2023 to allow the over-the-counter sale of progestin-only birth control, noting myriad evidence of the safety and efficacy of the medication in preventing
unintended pregnancies.
In 2017, as contraceptive access was being clawed back in states across the country and Congress attempted to dismantle the Affordable Care Act (ACA), the Medical Society participated in a coalition of organizations that fought to codify federal no-copay
contraceptive provisions from the ACA into Massachusetts law. With the passage of the Contraceptive ACCESS law in November 2017, the Commonwealth protected access to no-copay birth control, expanded access to emergency contraceptives, and authorized
12-month prescriptions in a single dispensing. Several years later, to address low education about the law and uptake of its provisions, the MMS partnered with regulators at the Division of Insurance to host an educational webinar for physicians to
share guidance on the law’s basic parameters.
Racial Inequities in Maternal Health
The Medical Society is committed to combating the rise in maternal morbidity and mortality and the racial disparities therein. The United States has the highest maternal mortality rate among developed nations and is the only such country whose rate is
on the rise. Racial disparities in maternal mortality are staggering, with African-American, Native American, and Alaska Native women dying of pregnancy-related causes at approximately three times the rate white women in the United States. Research
has shown that these disparities persist, even when controlling for factors like income, prenatal care, and maternal age. In Massachusetts, where a Black birthing individual is twice as likely to die from pregnancy-related complications as a white
person, overall rates of pregnancy-associated mortality increased by 33% from 2012 to 2014 alone, the most recent period for which data is publicly available. These disparities are seen in other aspects of maternal health. The prevalence of severe
maternal morbidity nearly doubled in the Commonwealth from 2011 to 2020, with Black non-Hispanic birthing people consistently experiencing the highest rates of labor and delivery complications among all races and ethnicities.
To address these inequities in maternal morbidity and mortality, the Medical Society joined a coalition that pushed to establish a legislative commission to study and make recommendations to address racial disparities in maternal health. The MMS was represented
on this commission by the accomplished Dr. Charles L. Anderson, president and CEO of The Dimock Center, and is working to codify several of the commission’s key policy recommendations into state law. One such recommendation is to increase access to
culturally competent doula support. As such, the MMS is proud to support legislation to establish Medicaid coverage for doula services, which we believe is important to reducing health disparities for birthing people of color.
Perinatal Mental Health
Recognizing the need for comprehensive care that addresses the mental health needs of patients during pregnancy and the postpartum period, the Massachusetts Medical Society is actively engaged in legislative advocacy at the state level to expand affordability
and access to these critical services.
As part of this effort, the MMS joined “Mind the Gap,” a statewide coalition of more than 30 organizations that are committed to passing the Massachusetts Moms Matter Act. This legislation calls for two new grant programs to expand and diversify the perinatal
mental health workforce and invest in community programs that support the mental health and well-being of birthing people and other new parents.
The MMS further supports legislation to require insurance carriers to cover postpartum depression (PPD) screening in pediatric offices up to twelve months after delivery. Although many pediatricians have integrated PPD screening into their practice, health
plans in Massachusetts are not required to provide coverage for this clinically important service in pediatric settings, leading to costs being passed along to patients. The Medical Society believes this proposed coverage expansion is fundamental
to advancing maternal and infant health in Massachusetts.
Additional Sexual and Reproductive Health Advocacy Efforts:
- The MMS supports, An Act relative to parentage to promote children’s security (H.1602/S.1103).
- The MMS supports An Act relative to LGBTQ family building (S.622).
- FY23 state budget conference committee letter in support of expanding access to PrEP HIV medication for adolescents.
- Testimony in support of requiring insurance coverage for fertility preservation.
- Testimony in support of legislation requiring separate coverage for postpartum long-acting reversible contraceptives, unbundled from global payments for labor and delivery.
- Testimony in support of extending MassHealth postpartum coverage from 60 days to 12 months and providing that extension to all eligible individuals regardless of immigration status.
- Testimony in support of mandating abortion and abortion-related care within the coverage mandate for prenatal care, childbirth, and postpartum care, without cost-sharing.
- Comments relative to reproductive and maternal health legislation.
- Testimony in support of requiring Medicaid coverage for doula services.
- Testimony in support of comprehensive, age-appropriate sexual health education.
- Testimony in support of timely, systematic monitoring of fetal and infant mortality in Massachusetts.
